Grip on prognostic factors after forearm fractures

Het doel van dit proefschrift was om meer kennis en begrip te krijgen van onze beschikbare beeldvorming en interpretatie van niet-invasieve tests om de uitkomst van een specifieke behandeling te voorspellen. Dit onderzoek werd gestart met het testen van beschikbare classificatiesystemen met gewone rontgenopname van de pols na een onderarmfractuur. Hoewel er verschillende fractuurtypes zijn van polsbreuken, die over het algemeen worden erkend, is de variabiliteit van het scoren hiervan bij traumatologen hoog. Dit betekent dat er geen overeenstemming bestaat voor een goed classificatiesysteem. Sommige fracturen hebben een karakteristiek patroon en zijn als groep eenvoudig in te delen. Een objectieve meting om deze fracturen te vervolgen zou ideaal zijn. Dit kunnen we vinden in knijpkracht. Hoewel de niet-indexarm voldoende zou kunnen zijn als controle, zal er altijd een verschil zijn vanwege handvoorkeur. Onderzocht werd wat normaal zou zijn in een gezonde juveniele populatie voor beide handen, rekening houdend met handvoorkeur. Ook werd een studie uitgevoerd bij een gezonde volwassen populatie voor normatieve gegevens van pronatie- (onderarm endorotatie) en supinatie- (onderarm exorotatie) kracht van de onderarm. De resultaten van de normatieve volwassenen werden gebruikt om verminderde pronatie- en supinatie-kracht te relateren aan dezelfde kracht-metingen bij patiënten met een ligamentair letsel bij een breuk. Dit letsel kan specifiek zijn voor bepaalde fractuur type, wat de uitgangspositie voor de test was. Tot slot hebben we röntgenfoto's van kinderen met onderarmsfracturen beoordeeld. De verschillende uitgevoerde onderzoeken beoordeelde specifieke radiografische eigenschappen van de fracturen. Deze werden gebruikt om een conservatief behandelresultaat te voorspellen, wat vervolgens in de tijd werd beoordeeld

Follow-Up in Bone Sarcoma Care:A Cross-Sectional European Study

Background. Follow-up of high-grade bone sarcoma patients with repeated radiological imaging aims at early detection of recurrent disease or distant metastasis. Repeated radiological imaging does expose (mostly young) patients to ionising radiation. At this point, it is not known whether frequent follow-up increases overall survival. Additionally, frequent follow-up subjects patients and families to psychological stress. This study aims to assess follow-up procedures in terms of frequency and type of imaging modalities in bone tumour centres across Europe for comparison and improvement of knowledge as a first step towards a more uniform approach towards bone sarcoma follow-up.Methods. Data were obtained through analysis of several follow-up protocols and a digital questionnaire returned by EMSOS members of bone tumour centres all across Europe. Results. All participating bone tumour centres attained a minimum follow-up period of ten years. National guidelines revealed variations in follow-up intervals and use of repeated imaging with ionising radiation. A local and a chest X-ray were obtained at 47.6% of the responding clinics at every follow-up patient visit.Conclusions. Variations were seen among European bone sarcoma centres with regards to follow-up intervals and use of repeated imaging. The majority of these expert centres follow existing international guidelines and find them sufficient as basis for a follow-up surveillance programme despite lack of evidence. Future research should aim towards evidence-based follow-up with focus on the effects of follow-up strategies on health outcomes, cost-effectiveness, and individualised follow-up algorithms.</p

Follow-Up in Bone Sarcoma Care:A Cross-Sectional European Study

Background. Follow-up of high-grade bone sarcoma patients with repeated radiological imaging aims at early detection of recurrent disease or distant metastasis. Repeated radiological imaging does expose (mostly young) patients to ionising radiation. At this point, it is not known whether frequent follow-up increases overall survival. Additionally, frequent follow-up subjects patients and families to psychological stress. This study aims to assess follow-up procedures in terms of frequency and type of imaging modalities in bone tumour centres across Europe for comparison and improvement of knowledge as a first step towards a more uniform approach towards bone sarcoma follow-up.Methods. Data were obtained through analysis of several follow-up protocols and a digital questionnaire returned by EMSOS members of bone tumour centres all across Europe. Results. All participating bone tumour centres attained a minimum follow-up period of ten years. National guidelines revealed variations in follow-up intervals and use of repeated imaging with ionising radiation. A local and a chest X-ray were obtained at 47.6% of the responding clinics at every follow-up patient visit.Conclusions. Variations were seen among European bone sarcoma centres with regards to follow-up intervals and use of repeated imaging. The majority of these expert centres follow existing international guidelines and find them sufficient as basis for a follow-up surveillance programme despite lack of evidence. Future research should aim towards evidence-based follow-up with focus on the effects of follow-up strategies on health outcomes, cost-effectiveness, and individualised follow-up algorithms.</p

Long-Term Halo Follow-Up Confirms Less Invasive Treatment of Low-Grade Cartilaginous Tumors with Radiofrequency Ablation to Be Safe and Effective

Background: Radiofrequency ablation (RFA) is a minimally invasive alternative in the treatment of bone tumors. Long-term follow-up has not been described in current literature. Detailed analysis of mid- and long-term follow-up after RFA treatment for a cohort of patients with low-grade cartilaginous tumors (atypical cartilaginous tumors and enchondroma) was performed. The results, complications, and development of halo dimensions over time are presented. Methods: Data of all patients with an RFA procedure for an ACT between 2007-2018 were included. Ablation area is visible on baseline MRI, 3 months post-procedure, and is called halo. Volume was measured on MR images and compared to different follow-up moments to determine the effect of time on halo volume. Follow-up was carried out 3 months and 1, 2, 5, and 7 years after the procedure. Occurrence of complications and recurrences were assessed. Results: Of the 137 patients included, 82 were analyzed. Mean follow-up time was 43.6 months. Ablation was complete in 73 cases (89.0%). One late complication occurred, while no recurrences were seen. Halo dimensions of height, width, and depth decreased with a similar rate, 21.5% on average in the first year. Subsequently, this decrease in halo size continues gradually during follow-up, indicating bone revitalization. Conclusion: RFA is a safe and effective treatment in low-grade cartilaginous tumors with an initial success rate of 89.0%. Extended follow-up shows no local recurrences and gradual substitution of the halo with normal bone

Grip strength is strongly associated with height, weight and gender in childhood:a cross sectional study of 2241 children and adolescents providing reference values

QuestionWhat are reference values for grip strength in children and adolescents based on a large and heterogeneous study population? What is the association of grip strength with age, gender, weight, and height in this population?DesignCross-sectional study.ParticipantsParticipants were recruited from schools in the northern provinces of the Netherlands. The study included healthy children and adolescents ranging in age from 4 to 15 years.Outcome measuresAll children had their height (cm) and weight (kg) measured and were allowed a total of four attempts using the Jamar hand dynamometer: twice with each hand. Grip strength scores (kg) were recorded for the dominant and non-dominant hands.ResultsThe study population comprised 2241 children and adolescents. Reference values for both genders are provided according to age and dominance. Grip strength shows a linear and parallel progression for both genders until the age of 11 or 12, after which grip strength development shows an acceleration that is more prominent in boys.ConclusionThere is a significant difference in grip strength with each ascending year of age in favour of the older group, as well as a trend for boys to be stronger than girls in all age groups between 4 and 15 years. Weight and especially height have a strong association with grip strength in children